First night on apap - unusual results?

[SleepingBeauty]

I had my first night on the apap machine last night. First, I slept amazingly well. Almost more of "falling unconscious" as opposed to what I've been calling sleep! I closed my eyes at 11:00 p.m. and the next thing I was aware of was my alarm a 6:00 a.m. Amazing!

What I'm wondering about is the 90% average reading I received. My setting was supposed to be 8 according to the sleep test I had 3 months ago. The 90% average on the machine this morning was 11.5. Is that normal to have it off by 3 or so?

I must say I feel much better on the apap at 11.5 than using the rental machine I had set at 8, so I have no desire to change anything. I just wondered if this was something others new to apap experienced as well.

I'm really glad I went with the apap machine. I feel like I will be getting a more accurate amount. And since I sometimes take Vicodin before going to sleep, (my neurologist said it makes the sleep apnea worse??) I am comforted to know that if I need a bit more pressure on those nights, it's going to be there.

[Wulfman]

Your "90%" pressure doesn't mean that you spent 90% of the night at that pressure. It means that that was the pressure that it reached to equal 90%. In other words, you spent 90% of the whole night AT or BELOW that pressure.

Den

[oldgearhead]

Is your APAP in "Auto" mode? If so, what are the min/max pressure settings?

[SleepingBeauty]

Yes, it is on apap mode. The pressures were set between 4 and 20.

I realize I didn't spend 90% of the night at that pressure, it just surprised me, that it would go above the setting of 8 recommended at the sleep clinic. I guess I thought it would vary between 4 and 8 somewhere, depending on need.

And I think of the nights spent on the rental unit at 8 with no ability to go higher.

Do other apap users experience a wide variation from day to day? If so, shouldn't we all be using an apap so the machine can determine our optimal need moment to moment?

Sorry for so many questions...I'm still learning

[yardbird]

day-to-day variances? yup... my titrated pressure is 8 as well and my machine will run up to 10 or 10.5 almost every night. Not for very long. Sometimes only for a few mintes. Other nights it will be at the higher pressure for longer... maybe 30 minutes total (not 30 minutes all at the same time). In MY case, and after I had asked my wife to kinda keep an eye on me a few times, it appears as though I require that higher pressure when I roll onto my back.

And while my pressure was determined by the sleep lab to be 8, I spend MOST of my time at 6 or 7. So my autoPAP is set to range between 6 and 11. When it was at 4 for the low end, I felt like I wasn't getting enough air. So I upped the low end to 6. When I had the high end set at 10, I noticed I was at times REACHING 10 so I upped the high end to 11 and I never reach that.

Ranging an autoPAP between 4 and 20 is *generally* not going to be considered optimal. Most people narrow the range more in line with what their needs turn out to be.

HOWEVER (and it's a BIG "however"...) if the therapy is WORKING FOR YOU with the machine set to range between 4 and 20.... the only real reason you'd have to change anything would be to see if you can get the therapy to work even better.

One of the most COMMON things we find as we all talk about our experiences here, is that what works for one, does not necessarily work for another.

But we're ALL here to help you figure out what works for you. Sounds like you're doing great.

[Snoredog]

that is great. Normally you don't leave the machine set at its wide open defaults, but if you sleep really well that is the most important thing.

As for the 3cm or so difference? You would have to pull out a copy of your original PSG report and read it carefully to help with that answer. They try to use the pressure that offers you the best sleep, but if events pop up as a result of that pressure they back off a bit. Could be the PSG tech was trying to avoid some events such as CA or MA events with the lower pressure. If no CA or MA events were listed on your report you can safely use that 11.5 found pressure. But if the next few nights it starts climbing beyond 11.5cm, then it would become a concern to me.

vicodine or hydrocodone: Your neuro is correct, that stuff does make OSA worse along with being highly addictive. If it was taken before your PSG it could have had an impact on the results. What pains are you trying to control with it? Hopefully you are only on it short term.

Sleep with the current settings for a few weeks, hopefully you will continue to feel great (if so make NO change). But we all have our ups and down days/nights, so I would write down your current settings. But if you don't feel so hot down the road you might want to consider increasing the bottom or Auto:Min pressure from the default 4cm. Most people starve at that pressure. If the PSG lab found 8cm to be your ideal, you could alternately set up your machine to the following:

Therapy Mode=Auto
Cflex Setting=3
Auto:Max=12cm
Auto:Min=8cm
AutoRamp Timer=30 minutes
AutoRamp Pressure=6cm
Mask Alert=On
AutoOff=Off
Show AHI/Leak=On

The M series auto has some great features, you can increase your Min. pressure higher and increase Cflex setting to compensate for the higher pressure and it could have a huge impact on how you feel the next day. For those bad nights that we all have, you have AutoRamp available to drop pressure down vs. not using the machine.

The way it would work:

Turn on machine, it starts at 8cm pressure
Now free to move on up to 12cm pressure (actually it can go to 13cm).
Cflex setting of 3 would make it feel like you were back at a lower pressure.
On a bad night or if awakened during the night you can optionally press the Ramp button, machine would drop even further down from 8cm to 6cm pressure for 30 minutes and allow you to more easily get back to sleep. After a while you will get used to the 8cm and not need the AutoRamp, but it is still there should you need it.

[SleepingBeauty]

Thank you snoredog and yardbird! The settings were wide open like that when I received the machine on Tuesday, and it hadn't occurred to me yet to alter them.

I agree, the bottom setting of 4 wasn't enough air. I think I will up it as you suggested. I think I would also feel better (that is mentally feel better) about dropping the high end too. I don't think I'd ever get up to 20.

And as for the Vicodin use, unfortunately, it seems I may be on it forever. I had a cervical disk replacement surgery (two disks replaced with donor bone) a year ago and a titanium brace put in. I've seen three doctors since the surgery and they all tell me the same thing - surgeons are great at repairing the physical component, but they can't surgically do much for the nerve damage and resulting pain. I've been labeled a long term pain management patient. I was hoping it would lessen with the final fusing, but apparently there is the additional issue of scar tissue.

I'm VERY cautious about the Vicodin. I work sitting in front of a computer and the pain was just too much to handle. I use a half a Vicodin on an as-needed basis - not to totally remove the pain, but to back it down so I can work effectively. Sitting is really hard for me.

I am working very closely with my doctor to help monitor the amount I take. The addictive feature does scare me.

I also use massage and a tens unit, but can't quite see my office allowing a masseuse to come to work with me each day!

I am actually going to start a new medication this weekend that was developed for depression, but in low doses is supposed to help with pain management. I'm hopeful!

With my recent switch to a new insurance and consequently a new doctor, I made sure to let him know I don't just want a bunch of pain drugs thrown at me to shut me up. I'm hoping there is a new pain med in the works that isn't as dangerous. Quite honestly, I hate taking them.

[snoregirl]

which anti depressent is it? Hope you don't mind asking, just curious as I was asked to try something like this for headaches years ago and I found the antidepressent useless for my pain. But then again, what doesn't work for one, does for another.

Good luck, hope the change of meds works for you. But if it doesn't go back to the doc for more options.

[SleepingBeauty]

Hi snoregirl. It's called Nortriptyline. The usual dose for depression is supposed to be 100 mg, but low doses - 10mg to 20 mg is supposed to help chronic nerve pain. I really hope it works.

I'm sorry it didn't work for you. Did you find something that did?

[Katerama]

I too suffer from neck pain, although not as serious as what you have described. When it interrupts my daily functioning, I take 1/2 percocet . . . and I hate it too.

I wanted to chime in here to try to reassure you about pain med addiction. Recent research regarding chronic pain has shown that people who take narcotics for pain relief do not have the same reaction to pain meds as those who are taking them for the high. Although the body will become physically dependent on the pills (meaning you will need to wean off and not go cold turkey), it is not the same as the classic definition of addiction. When you start taking those pills when you don't need them for pain, THEN you have a problem.

I am happy that you have an auto that can adjust when you do need to use your medicine. I do not have my cpap yet (had my titration study, but doc hasn't called for my follow-up/prescription), but I made sure I told them that I do occasionally use the percocet and muscle relaxants so that they would take it into consideration when planning my treatment.

[Sleepless_in_LM]

Congrats, Sleeping Beauty!

I just wanted to chime in that I also went through thet exact same surgery, but have had better results. My surgeon told me the quicker I had the surgery, they less likelyhood of permanent nerve damage, so I did it quickly. However, I have had two lower back surgeries also and deal with chronic back pain (but not extreme). My sleep doc has me on Clonazepam. He claims it is very good helping with sleep problems due to pain. It has helped me greatly. I still wake up several times a night, but am able to drift right back to sleep. It is not a narcotic, so the physical addiction worry isn't there, but he told me that in some people their body builds up a resistance and is looses some of its effectiveness. I haven't found that to be the case for me. Another benefit is that it is cheap. A 30 day supply doesn't get up to my $10 co-pay.

You might want to ask your doc about it sometime. It might not be right for your level of pain, but I found it more efective then vicatin. I have never taken it during the day because it does make me sleepy.

[yardbird]

ahhhh.... I had a spinal fusion here as well. They used bone from my hip. The disk at C4/C5 had deteriorated over time and finally just came apart. (old compression fracture accident). I have nerve damage so bad that there are muscles that are simply gone. The nerves that should be telling them to fire are either gone or not working.

I can tell you if you haven't already done this, to get your vitamin B up. The B compounds really helped me. They can cut down on the amount of chemical pain relief you have to take. In my case, 8 years later, I don't take any pain meds at all.

[SleepingBeauty]

I hadn't heard about the vitamin B link with pain management. I guess I have a lot of reading and research to do!

Are you increasing your B through an over-the-counter supplement, prescription, or food source?

[telly]

And as for the Vicodin use, unfortunately, it seems I may be on it forever.

Hey SB,
Not true SB, since you live in the Great State of California, you DO NOT have to be on vicodin forever. Don't buy into the hype.

In '96, I, too, had a back surgery which was a Microdiscectomy (partial removal) of my L4 Disk. I have to deal with pain daily, which is not heinous, but sometimes flares up to the point where I would need to down at least 4 Alleves (very bad for the liver) to kill it off. And once in awhile, I'd need "Uncle Vic" in the past. However:

I HATE VICODIN. And I'm suspicious of all over-the-counter pain meds and the companies that make them.

It's a powerfully addictive pain medication made by EVIL drug companies out to make you a regular "customer" (read: junkie). These drug companies are happy to hook you on their "junk", just like cigarette companies.

And how does vicodin make you feel? Sure it kills the pain. But at what cost?

It makes me feel irritable and itchy all over. YUCK. Like Heroin, Morphine and Codeine, vicodin is an OPIATE and it will hook you in a powerful way without an easy way to kick. One of my friends is trying to kick Vicodin right now and he's having a really tough time of it. Ever try to kick cigarettes or HEROIN? Yep, it's gonna be about that hard to kick. No way would I addict myself to that evil stuff! I suggest you flush those vicodins, ibuprofin and aspirin down the john. These pain meds are all not good for the body at all. Or did you already know that and did not know of a legal alternative? There is hope! It comes in the form of an herb that you very well know of.


Warning: Drug Controversy Alert. I'm going to talk about MEDICAL MARIJUANA (AKA POT AKA Mary Jan AKA Mary J. Juana AKA Skunk AKA Bud AKA Harry POTter AKA Henry the "Eighth")

If the idea of using medical marijuna is too much for you. Stop reading here.

Now, what I'm going to suggest to you will likely be extremely controversial on this forum but in California (thanks to Prop. 215), you can use Medical Marijuana (AKA MMJ) for pain relief totally LEGALLY. I use it for my pain management and it really works great (certain kinds work better than others, amazingly).

Before asprin was invented in the late 1800's, medical cannabis was routinely used (typically in oral or tincture format) for pain relief. In fact, it has been used for pain medication for over 4,000 years. Ancient doctors also used it to cure insomnia and a host of other disorders.

Hemp and cannabis was completely legal until the 30's when W.R. Hearst led the campaign against the plant because of the politics of the production of paper of all things. So we can blame big business (drug companies and Hearsts media empire) and a corrupt government for taking away this completely valid pain medication away from needy patients. Pot has a bad rep, but I assure you, it is safe and useful if used properly.

BEFORE THE REEFER MADNESS CAMPAIGN
Historical Name -- Cannabis
Used experimentally to treat opium drug addiction
Medially recognized as an anti-Spasmodic agent
Medically recognized as a sedative
Recognized and was used to treat Mental Illness
Was medically used to treat nervous Tension
A harmless medical agent that not even quacks wanted to use
Users were called Patients

DURING THE REEFER MADNESS CAMPAIGN
Now re-named --Marihuana
Now called a dangerous habit forming drug
It use leads to uncontrollable muscle twitching
Causes violent reactions, which often lead to acts violence and murder
Its use leads to and was the cause of insanity
Such a dangerous stimulant that its use causes young girls to jump out of windows
A dangerous drug, as deadly as a coil rattle snake
Users were now being called drug Addicts

The entire story of the conspiracy is well documented in "The Emperor Wears No Clothes". Read it. It will blow your mind.

Since 1996, Medical Marijuana has been readily available for California Residents in need of this fantastic pain medication. Finding a holistic doctor that will write you an Rx is not difficult to find. Just look in one of the local "indie" papers (LA Weekly, SF Bay Guardian or the like) and you will see the ads.

In LA, this is a simple process. The doc will examine and interview you, and ask about your current pain meds. When you say, "Vicodin", I can predict that with your condition, you will be qualified. After paying fees of around $150, you get an ID card.

With this card, you can go to a local Medical Cannabis Club and procure your medication. The best clubs have a cool vibe and a holistic environment, like a cross between a pharmacy and a cafe. There you can ask for advice. You see, there are various strains (and strengths) for various ills. The more expensive kush varieties will soothe back pain, as it is one of the strongest strains. Take 2 hours before bedtime and it will take the pain away quite nicely with the side benefit of getting you drowsy enough to easily drop off to sleep.

A lighter sativa variety will be good for daytime pain management when you need it. These are good, because it will soothe the pain and you can still keep your head in the game and on your daily activities. IOW, if you are in pain - it will affect your pain and it won't cloud your head, well, not too much anyway.

If you are opposed to smoking the herb, you can eat it in the form of infused butter or chocolate. It takes a bit longer, but it is much safer and better on the body. Since the active ingredient, THC, is an oil soluable drug, infusing it with oil or butter will release it into the food for ingestion. The chocolate or butter is a delicious alternative to Vidodin for certain. The doctor will recommend this method. A vaporizer is another safe alternative.

If you are opposed to this idea, that's OK. I'm just throwing it out there because it worked for me in all the best ways. I have used cannabis for a long while for my ills, so I can definitely recommend it. It is not physically addictive, so I can do without it with no issues when I am traveling or with family that "doesn't get it". If I need pain meds while traveling in CA, I take my ID card with me and procure in a local club.

You are not breaking the law if you have an ID card and Rx for MMJ. It is legal medication, like any other Rx. Yes! You can grow it in your backyard without legal penalty (side note: if you have a green thumb, it's a fun hobby to "grow your own"). Similar to alcohol, the CA Highway patrol is alerted to not arrest you if you are pulled over in possession of medical cannabis in your car, as long as you are not under the influence of MMJ and have your ID card. It is advised NOT to operate machinery while using MMJ, and I agree with this even though it is not nearly as debilitative as alcohol, IMO.

In California (and other progressive states), MMJ is a valid and TOTALLY LEGAL way to treat your pain w/o side effects or addiction. Don't wanna smoke it? Eat it! AND, unlike Vicodin, or even Aspirin, no one has EVER overdosed on MMJ as it is virtually impossible. Unlike Ibuprofin, it will not damage your liver ONE BIT. Unlike Aspirin, it won't make you BLEED INTERNALLY. I don't believe it has an adverse effect on your sleep, in fact it is probably good for it!

You think you guys are geeky about your CPAP gear? Well, I'm the same way about MMJ. Safe ways to ingest, the positive effects of different strains and blends. I guess all I gotta say is, "MMJ RULES!".

MMJ has an overall negative connotation in society, but I tell you IT WORKS. Don't listen to the critics and do a little research. You may be surprised in what you find, a lot of positivity in the MMJ community, much like this one.

I think that many pain meds should be abolished as they can be soooo dangerous. Even aspirin! In fact, my younger brother nearly died from internal bleeding only months ago from taking a bit too much aspirin. He was in the hospital for 6 days.

So, now that I've come out as a proponent of MMJ, I'm ready to answer all your questions and, of course, to receive your barbs, jokes and ribbings. Let 'em RIP!

UP with MMJ, DOWN with evil pain medication like Vicodin! .